U.S. DEPARTMENT OF COMMERCE

OFFICE OF SPACE AND BUILDING MANAGEMENT (OSBM) WORK REQUEST HERBERT C. HOOVER BUILDING

CD-410 NUMBER (To be completed by OSBM) RECEIPT DATE

SECTION 1: REQUEST FOR SERVICES (To be completed by Operating Unit)

OU Control Number (Optional) Requesting Operating Unit

Operating Unit POC

Description of Products and/or Services including the location of work and the bona fide need

Attachments

SECTION 2: COST ESTIMATE (To be completed by OSBM)

Project Coordinator

Items/Tasks Cost Estimate

Detailed Estimate Attached

Total

Type of Requirement: Severable Non Severable

Final Costs

Page 1 of 3

Assisted Acquisition: Yes No

New

Amendment- Complete only blocks being changed

Cancellation - Provide explanation and effective cancellation date in Description Box below

Changes are not effective until after a revised cost estimate is provided (SECTION 2), Funds Authorization (SECTION 3) and Project Acceptance (SECTION 4) are completed

(See instructions for definitions)

Note: During the period in which a Presidential Appointee holds office with in the HCHB, funds for their office refurbishment may not be obligated or expended in excess of $5,000, pursuant to an annual restriction in appropriations legislation. See Instructions for additional direction.

Does the work request involve an area assigned to a Politically Appointed Official? Yes No

DOC CD-410 (REV 11-16)

Phone Number: Email Address:Name:

Phone Number: Email Address:Name:

U.S. DEPARTMENT OF COMMERCE

CD-410 NUMBER: SECTION 3: WORK PERFORMANCE/FUNDS AUTHORIZATION (To be completed by Operating Unit after Section 2 Estimate has been received)

OU Control Number:

Amount of Funds Allocated Operating Unit Accounting Data/Funding String

Funds Year Expiration Date of Obligational Authority

Agency Location Code (ALC)

BPN/DUNS Number Business Event Type Code (BETC) DISB

Treasury Account Symbol (TAS)

Final Project Expenditure Funds Available to be De-obligated

OSBM Agency Location Code (ALC) BPN/DUNS Number Business Event Type Code (BETC) COLL

Treasury Account Symbol (TAS)

Statutory Authority: Working Capital Fund (15 USC 1521)

SECTION 6: BILLING (To be completed by OSBM) Partial Billing 1 $ Date: Partial Billing 2 $ Date: Partial Billing 3 $ Date:

Partial Billing 4 $ Date:

CD-410 Billed and Closed Name: Signature: Date:

SECTION 4: Project Acceptance

Page 2 of 3

Name: Signature: Date:

DOC CD-410 (REV 11-16)

Statutory Authority: Working Capital Fund 15 USC1521

Funds/Budget Certifying Official (CFO signature required for Political Appointee projects)

Date:Name: Signature:

Signature certifies that internal reviews/approvals by the Operating Unit (OU) have been completed; that the OU has a bona fide need in the current fiscal year for the work described; that the funds identified are legally available for obligation and expenditure in furtherance of the work described; and that the OU accepts the General Terms and Conditions set forth on Page 3 of this form. If the funds identified in this section are insufficient to complete the work requested under this agreement, an amended CD-410 with additional funding will be required prior to incurrence of costs above the certified amount. OSBM will bill in accordance with the Federal Management Regulation (41 CFR) Section 102-85.195 on task completion. Overtime Utilities will be billed quarterly or at the end of the period of performance. All projects greater than $100,000 will be partially billed after $50,000 has been expended. Funds are obligated upon project acceptance by OSBM in Section 4, which follows signature of Section 3.

Name: Signature: Date: Operating Unit Approving Official

OSFM Authorization (for OS Projects over $25,000)

Director OFEQ Clearance (Applies to 1. Political Appointee projects over $25,000 and 2. All projects within 2 years of GSA Modernization/Renovation)

Deputy ASA Clearance (Applies to 1. Political Appointee projects over $50,000 and 2. Projects over $50,000 that are within 2 years of GSA Modernization/Renovation)

OGC Clearance (Applies to 1. All projects over $150,000 and 2) Political Appointee projects requiring clarification)

SECTION 5: PROJECT COMPLETION (Project materially complete)

Operating Unit Representative Date:

Project Coordinator Signature: Date:

Name: Signature:

Date:Name: Signature:

Work Request Dates A. Start: B. Completion:Signature certifies that OSBM will start work, bill, collect and properly account for funds from the Operating Unit, in accordance with this agreement.

Project Acceptance (To be completed by OSBM Project Coordinator)

Date:Name: Signature:

Date:Name: Signature:

Date:Name: Signature:

Page 3 of 3

GENERAL TERMS AND CONDITIONS

1. The Operating Unit (OU) will establish the existence of a bona fide need to be satisfied through this CD-410 Work Request.

2. The OU will provide OSBM with such requirements/Statement of Work (SOW), budget/accounting information, points of contact, and other information necessary for OSBM to perform the work.

3.

4. For assisted acquisitions OSBM and the OU agree that the work will be performed in full compliance with the Competition in ContractingAct and other applicable laws and regulations. In furtherance of so doing: a) OSBM will assist the OU in further defining its requirements in a manner that will aid in OSBM's timely performance of the work;b) OSBM will perform acquisition planning related to any procurement actions to be undertaken in connection with the work, including,

as appropriate,i. developing and implementing an acquisition strategy responsive to the OU's requirements;ii. conducting market research;iii. developing performance-based solicitation requirements when project requirements allow; andiv. considering all appropriate acquisition vehicles and procurement methods to maximize competition and best value.

c) OSBM will comply with requirements of the Federal Acquisition Regulation (FAR).

5. For assisted acquisitions OSBM will administer contracts and resolve contractual issues or disputes arising out of OSBM's performance of the work, including: a) enforcing contractual terms and conditions to facilitate the timely delivery of goods and services;b) maintaining contract documentation from project initiation through contract closeout;c) performing contract oversight, including inspection and acceptance of the work, in accordance with the terms of the contract;d) tracking and reporting on the contractor's performance of the work; and e) performing contract close-out functions.

6. The OU will not, except as expressly authorized in writing by OS Office of Acquisition Management (OAM), provide instruction or authorization to any OSBM contractor regarding performance of the work.

7. For assisted acquisitions OSBM will provide representation for contract disputes, claims and bid protests arising out of OSBM's performance of the work. The OU will be responsible for all costs associated with termination, disputes, and protests, including settlement costs, except that the OU will not be responsible for costs associated with actions stemming from errors by OSBM in performing its responsibilities under this CD-410 Work Request. OSBM will consult with the OU before agreeing to a settlement for which CD-410 Work Request funding will be used.

8. The OU will provide funding to cover OSBM's direct and indirect costs of performing the work, including costs associated with OU changes to the work or increases in cost not attributable to OSBM errors in performing its responsibilities under this CD-410 Work Request.

9. In no event will OSBM be required to commence performance of the Work until the OU has provided OSBM with funding in an amount sufficient to cover the expected costs of performance. Funds will not be accepted until after the scope of work is fully defined, all design iscomplete, a schedule drafted and final cost estimates generated.

10. OSBM will be a good steward of the OU's funds and provide the OU with periodic updates regarding OSBM's further obligation and expenditure of CD-410 Work Request funding. Upon agreement completion and close-out of all contracts associated with this CD-410 Work Request, OSBM will return to the OU any unused funding.

11. OSBM will provide the OU with an expenditure ledger and respond to OU inquiries regarding OSBM expenditure of CD-410 Work Request funding, as requested.

12. OSBM and the OU will advise each other of issues, concerns, or problems related to performance of the Work.

13.

14. OSBM and the OU agree to use their best efforts to resolve disputes cooperatively at the working levels of their respective organizations regarding the interpretation of the Work Request and the roles and responsibilities of the parties, and if necessary, to escalate such disputes within their respective organizations. Disputes regarding funding that remain unresolved for more than 60 calendar days will be referred to the respective OU Chief Financial Officers for resolution.

DOC CD-410 (REV 11-16)

The OU will provide cooperation and support to OSBM as required, for Office of Facilities and Environmental Quality (OFEQ) to fulfill its contracting responsibilities and otherwise, as necessary, for OSBM to perform the work.

CD-410 Work Requests are effective as of the date of signature by OSBM for project acceptance in Section 4 (which must be preceded by signature by the OU in Section 3), and will remain in effect until the completion date in SECTION 4, unless work is completed earlier or the agreement is terminated early or extended by written amendment. Any amendments to a CD- 410 Work Request, including these General Terms and Conditions, must be in writing and signed by both the OU and OSBM. A CD-410 Work Request may be terminated by the OU upon written notice to OSBM; provided that the OU will remain responsible to OSBM for any and all direct and indirect costs incurred by OSBM in connection with performance of the work up to the date of termination of the CD-410 Work Request, together with such costs related to termination of contracts entered into by OSBM in connection with the Work. Should OSBM seek to terminate a CD-410 Work Request, it will do so only with the written agreement of the OU, including costs attributable to each party arising out of any such termination.

INSTRUCTIONS FOR COMPLETING THE CD-410 GENERALComplete SECTION 1 and submit electronically to CD-410@doc.gov. The Office of Space and Building Management (OSBM) will issue a control number, contact the Operating Unit (OU) point of contact for all preliminary details and then provide a cost estimate for the work requested via SECTION 2. The CD-410 will be returned to the originating office to provide funding information via SECTION 3, and signature by a Funds/Budget Certifying Official and OU Approving Official. The form is to be returned electronically to OSBM for signature to accept the project (SECTION 4), at which point the order is placed and the obligation should be recorded by the ordering OU. SECTION 5 certifies the scope of work has been satisfied. SECTION 6 provides the final expenditures to be billed and amount of funds remaining, which are to be de-obligated. All fields should be typed or printed and separate CD-410s submitted for each distinguishable and separate project.

SECTION 5: PROJECT COMPLETION18. OSBM Project Coordinator to enter the date of physical completion of the project.19. Operating Unit official certifies that all requested work and/or services have been provided. No further work or services

will be provided once signed.

SECTION 6: BILLING20. OSBM billing official to date and sign when partial billing of a project has been conducted (if required).21. OSBM billing official to enter in final project cost and amount of funds available for de-obligation and date and sign when

final billing of a project has been completed. The CD-410 is considered closed.

DOC CD-410 (REV 11-16)

SECTION 4: PROJECT ACCEPTANCE

16. -410. The OU records the obligation as of the date of acceptance.The OSBM Project Coordinator signs to formally accept the CD17. Work request dates may be adjusted to accommodate OSBM resources and acquisition constraints.

SECTION 3: WORK PERFORMANCE/FUNDS AUTHORIZATION8. Requesting Operating Unit enters in the amount of funds allocated to the project, per the estimate provided in SECTION 2.

The Accounting Data (Project String) and funding details are to be completed in this section. 9. Funds Year – enter in the fiscal year of the funds.

10. All Office of Secretary (OS) projects over $25,000 must be routed to Office of the Secretary, Office of Financial Managementfor concurrence.

12. Operating Unit Approving Official signs to acknowledge the use of the available funds towards the project and returns form to OSBM.

SECTION 1: REQUEST FOR SERVICES1. Requesting Operating Unit - Enter the Office/Agency/Bureau who is requesting work.2. OU Control Number – Enter in specific Operating Unit tracking number if applicable.3. Enter the name and phone number of the Office/Agency/Bureau person designated as the representative for the requested work.4. Enter a full but concise statement describing the work requested, including the location. Attach additional information as necessary.5. Any project involving space occupied or substantially used by a political appointee shall be identified in this section. HCHB

Space Standards, Guidelines, and Procedures and Departmental Commerce Real Property Management Manual requirements are to be adhered to.

.

6. State if the task is Severable or Non Severable and if it is an Assisted AcquisitionSeverable: Where services are continuing and recurring, the contract or agreement is severable and the services must be charged to the fiscal year(s) in which they are rendered, unless authorized to cross fiscal years under 41 USC 3902. Non-Severable: A contract or agreement which is viewed as entire is chargeable to the fiscal year in which it was made,notwithstanding that the performance may have extended into the following fiscal year.Assisted Acquisition per 48 CFR 2.101 [Title 48. Federal Acquisition Regulations System; Chapter 1. Subchapter A. General; Part 2. Definitions Of Words And Terms; Subpart 2.1. Definitions], means a type of interagency acquisition where a servicing agency performs acquisition activities on a requesting agency's behalf, such as awarding and administering a contract, task order, or delivery order. http://definitions.uslegal.com/a/assisted-acquisition/

SECTION 2: COST ESTIMATE7. OSBM assigned Project Coordinator will enter in the specific project estimated costs for each group of items (including labor and

materials), as well as the total estimated project cost for the services requested. An itemized breakdown of all costs will be provided via separate attachment if required.

Funds/Budget Certifying Official – OU Budget Official certifies that the appropriate funds are available for the project. **OU CFOs are to certify all funds for projects involving Political Appointees.

11.

Projects over $25,000 involving a Political Appointee as well as all projects within 2 years of GSA Modernization/Renovation regardless of dollar value must be routed to Director, Office of Facilities and Environmental Quality (OFEQ) for concurrence.

13.

Projects over $50,000 involving a Political Appointee as well as all projects over $50,000 that are within 2 years of GSA Modernization/Renovation must be further routed to Deputy Assistant Secretary for Administration (D/ASA) for concurrence.

14.

All projects over $150,000 as well as projects for Political Appointees which require clarification require clearance from the Office of General Counsel.

15.